Healthcare Provider Details

I. General information

NPI: 1629231782
Provider Name (Legal Business Name): PASADENA ADVANCED SURGERY INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2008
Last Update Date: 07/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1044 S FAIR OAKS AVE SUITE 110
PASADENA CA
91105-2622
US

IV. Provider business mailing address

1044 S FAIR OAKS AVE SUITE 110
PASADENA CA
91105-2622
US

V. Phone/Fax

Practice location:
  • Phone: 626-768-4422
  • Fax: 626-768-4421
Mailing address:
  • Phone: 626-768-4422
  • Fax: 626-768-4421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: VALERIE KWAN
Title or Position: ADMINISTRATOR
Credential:
Phone: 626-768-4422